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* Required Information *Media Outlet: Print Online TV Radio *Address 1: *City: *State: Select one... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *Zip: *Phone: *Fax: *Website: Please fill out the name, email and mark the appropriate day and pass for each staff member attending below. Email addresses will be sent updates and confirmations. Contact information should be provided for each individual person attending. Do not include one person's contact information for every individual. Only one (1) photo pass will be permitted per outlet. Contact Information for 1st person: *First Name: *Last Name: *Email: *Phone: Cell Phone: Friday Pass Photo Pass Saturday Pass Video Pass Contact Information for 2nd person: First Name: Last Name: Email: Phone: Cell Phone: Friday Pass Photo Pass Saturday Pass Video Pass * Please provide a brief description of your assignment at Music Midtown.   I hereby certify that all the above information is true and complete, and I agree that any misrepresentation, regardless of time of discovery may cause for media credentials to be denied or taken away onsite during the festival. I Agree